Provider Demographics
NPI:1982994604
Name:BAO, XIAOHONG
Entity Type:Individual
Prefix:MR
First Name:XIAOHONG
Middle Name:
Last Name:BAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:BAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2523 WILLOWLAWN ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2526
Mailing Address - Country:US
Mailing Address - Phone:540-989-1390
Mailing Address - Fax:540-989-1390
Practice Address - Street 1:140 MAIN STREET
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171
Practice Address - Country:US
Practice Address - Phone:276-694-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist